In short. The alar base is soft tissue sitting on the maxilla. Its span depends on the nostril sill, the cheek and the midface below it, not on the nose alone.
Key points
- The only structure at the base that can be changed is the soft tissue; the maxilla underneath is not part of a nasal operation.
- That sets the limit on how far a base can be narrowed, and it is why the change is usually measured in millimetres rather than in a transformation of the lower third.
The alar base is the part of the nose most people are pointing at when they say a nose is wide. It is also the part least like the rest of the nose, because it is mostly not cartilage or bone. What holds it where it is decides whether anything can change it, and what the change would cost.
What the base is made of
The base is a composite. The outer wall of each nostril is skin over the fibrofatty tissue of the ala, supported behind by the lateral crus of the lower lateral cartilage. The floor of each nostril is the sill, a band of soft tissue between the opening and the upper lip. Beneath all of it is the maxilla, and the opening in that bone through which the nose passes. The span across the two alae is the result of all of these together, which is why two people with the same skin and the same cartilages can have bases of different widths.
Why it sits on the midface
Because the base is anchored to the maxilla, its width is partly inherited from the face rather than from the nose. A broad midface with a wide opening in the bone tends to carry a base that is correspondingly wide, and that width does not come from the soft tissue at all. Where this is the case, narrowing the soft tissue moves the ala inwards over a foundation that has not changed, and the result is a narrower base on an unchanged midface. That is not a reason to avoid it; it is a reason to know before deciding.
Soft tissue can be narrowed, the foundation cannot
The only structure at the base that can be changed is the soft tissue; the maxilla underneath is not part of a nasal operation. That sets the limit on how far a base can be narrowed, and it is why the change is usually measured in millimetres rather than in a transformation of the lower third.
The base in movement
The base is not fixed. Muscles running from the upper jaw to the ala and to the tip pull it outwards and downwards as part of a smile, and where that pull is strong the base is wider on movement than at rest. A width that appears only when you smile has a different cause from one present in a still face, and the first is not corrected by removing tissue. It is assessed by watching the base move, which is why the examination includes a smile rather than only a resting view.
Ask before agreeing to anything if
- The base is measured at rest only, and nobody has watched you smile.
- You are told the width comes from the nose when it sits on a broad midface.
- A narrowing is proposed without anyone saying how many millimetres it is.
What can be done about a base that is genuinely wide is covered in what alar base surgery can and cannot do.
Frequently asked questions
What is the nostril sill, and why does it matter for width?
The sill is the floor of the nostril, the soft tissue between the opening and the upper lip. Where the sill is full or low, the base is held outwards and the span measures wider than the alae alone would suggest. It is a separate structure from the ala and it can be addressed separately, which is one reason a base assessment looks at the floor as well as at the sides.
Why does the base of my nose spread when I smile?
Because muscles around the nose pull the alar base outwards as part of a smile. Where that movement is strong, the base is wider on movement than at rest, and the width a patient sees in a photograph of themselves smiling is not the resting width an examination measures. A base that flares on movement has a muscular cause, and it is not the same problem as a base that is wide when the face is still.
Does a wide alar base mean my midface is wide too?
Often, and not always. The alar base sits on the maxilla, so a broad midface tends to carry a broader base with it. But the base can also be wide on a midface of ordinary width, where the soft tissue of the ala is full or the sill is low. Which of the two is the case is decided by examining the base against the cheek rather than by looking at the nose by itself.
Risks & Limitations
- Every treatment on this ladder carries risk, and no result can be guaranteed.
- Narrowing the alar base leaves a permanent scar. It matures and fades over about a year, and it does not disappear.
- Every operation that narrows a nose also narrows the passage through it, which is why the airway is examined before any plan is made.
- An over-narrowed nose is difficult to reverse, because correcting it means adding tissue rather than removing it.
When to Seek Care
- A change in vision, or severe eye pain, after any filler or operation on the nose — seek emergency care immediately.
- Rapidly increasing swelling, spreading redness, warmth or fever after treatment on the nose — seek care promptly.
- Bleeding from the nose that does not stop with gentle pressure, or new blockage that is worse on one side.
- A growth, or a lesion on the skin of the nose that bleeds or does not heal.
- After an injury, where the shape of the nose has changed or breathing is affected.
References & Further Reading
- American Society of Plastic Surgeons (ASPS) — rhinoplasty and patient safety guidance
- National Institute for Health and Care Excellence (NICE, UK) — relevant guidance
- Cochrane Library — systematic reviews
- Chinese Medical Association Plastic Surgery Branch — clinical guidance
This page is patient education, not medical advice, and it does not cite individual studies. Discuss your own case with a qualified clinician. To arrange an assessment at Chongqing West District Hospital, see Contact & Consultation.